Bladder Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses medicines that kill cancer cells. Chemo attacks and kills cells that grow quickly, like cancer cells. But some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.

When might chemo be used for bladder cancer?

These are some of the ways chemo might be used to treat bladder cancer:

Before surgery to try to shrink a large tumor so that it's easier to remove by surgery. This may also help lower the chance that the cancer comes back after surgery.

After surgery to help lower the chance that the cancer will come back. Even if all of the visible cancer is gone or the bladder has been removed, chemo can kill any cancer cells that may be left behind.

Along with radiation to help it work better

To treat very early stage bladder cancers (Stage 0 and I) that are only in your bladder. (Intravesical chemo is used. It's described below.)

To treat bladder cancer that’s spread to other parts of your body

Your healthcare team will talk to you about the best treatment options for you. To help deal with the information and remember all of your questions, it helps to bring a family member or close friend with you to checkups. Bringing a written list of your concerns will also make it easier for you to remember your questions. It also may help to take notes on the things you talk about.

How is chemo given for bladder cancer?

The way you get chemo depends on your stage of cancer. There are 2 main ways of giving these medicines to treat bladder cancer:

Intravescially

Systemically

Intravesical chemo

This means the chemo is put right into your bladder. This may be used for early stage bladder cancers that are only inside the bladder. It may be used before or after surgery to remove tumors from the bladder wall. Intravesical chemo mainly affects the cells in your bladder that are in contact with the drug. It's less likely to harm other cells in your body. This means there are often fewer side effects.

You may get this type of chemo in your healthcare provider’s office or outpatient clinic. Treatment is often done once a week for about 6 weeks. The chemo is put into your bladder through a soft, flexible tube (catheter) The provider puts the catheter through your urethra and into your bladder. The provider drains the urine is drained out and puts in the chemo. It's left in for a few hours and then removed through the catheter. The catheter is then taken out. Sometimes the medicine is put in through the catheter and then the catheter is taken out. You’ll need to keep the medicine in for 2 hours, so you can't urinate during this time. After 2 hours, you’ll pass the medicine out with your urine.

The medicines most often used for intravesical chemo are:

Mitomycin. This is sometimes combined with heating the inside of your bladder. The combo may help the medicine work better.

Gemcitabine

Thiotepa

Valrubicin

Docetaxel

The length of treatment and how often it's done varies. Talk to your provider about the details of your treatment plan.

Systemic chemo

This means the chemo is given through a vein and right into your blood as an IV (intravenously). The medicines travel through your blood to reach your whole body. This means they may be able to kill cancer cells that have spread outside your bladder. This type of chemo is used to treat bladder cancer that has spread beyond your bladder. It may be given with radiation treatments.

Your healthcare provider may decide on a certain medicine or combination of medicines based on the stage of the cancer and your health history. There are many medicines that may be used for systemic chemo for bladder cancer.

When chemo is given along with radiation, the most commonly used chemo medicines are:

Cisplatin

Cisplatin and fluorouracil (5-FU)

Mitomycin-C and 5-FU

Paclitaxel plus cisplatin

Low-dose gemcitabine

When chemo is used by itself (without radiation), a combination of medicines is often used to make it work better. The combinations used most often for bladder cancer are:

Chemo is given in cycles. This reduces harm to healthy cells. Rest periods between treatments give normal cells a chance to recover. Your healthcare provider will decide if you need to get chemo daily, weekly, every few weeks, or monthly. Talk to your provider about how long you'll get chemo and what you can expect.

What are common side effects of chemo?

Side effects are common with chemo, but they can often be prevented or controlled. Most side effects from chemo often go away over time after the treatment ends.

Side effects depend on the type and dose of medicines you’re taking. They depend on the way you get the medicines (intravesical or systemic). They also depend on whether you're getting radiation at the same time, which can make side effects worse. They vary a lot from person to person.

Side effects from intravesical chemo may include:

Irritation in your bladder

Burning feeling in your bladder

Having to urinate more often

An urgent need to urinate

Blood in your urine

Discomfort or pain when passing urine

Skin rash

Some common short-term side effects from systemic chemo include:

Nausea and vomiting

Mouth sores

Constipation or diarrhea

Hair loss

Infections from low white blood cell counts

Easy bruising or bleeding from low blood platelets

Tiredness from low red blood cell counts

Loss of appetite

Dizziness

Skin problems, such as dryness, rash, blistering, or darkening skin

Tingling, numbness, or swelling in your hands or feet

Some medicines used to treat bladder cancer may cause kidney damage. Your healthcare provider may give you fluids through your IV to help prevent this. He or she may also tell you to drink lots of fluids before and after the chemo to help wash the medicines out of your kidneys.

Most side effects will get better between treatments and go away over time after treatment ends. You may also be able to help control and even prevent some side effects. Tell your healthcare providers about any side effects you have. They can help you manage side effects and keep them from getting worse.

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what signs to look for and when to call them. For example, chemo can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.